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National guidelines for chest- and abdominal physiotherapy

National guidelines for chest- and abdominal physiotherapy. Members in the working group.

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National guidelines for chest- and abdominal physiotherapy

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  1. National guidelines for chest- and abdominal physiotherapy Scandinavian Conference in Cardiothoracic Surgery 2009

  2. Members in the working group Maria AntonssonBSc, Akademiska sjukhuset, UppsalaMonika Fagevik Olsén, Associate professor, Sahlgrenska Universitetssjukhuset, GöteborgHenrik JohanssonMSc, Akademiska sjukhuset, UppsalaLena SandströmMSc, Karolinska universitetssjukhuset, StockholmCharlotte Urell, PhD student, Akademiska sjukhuset, UppsalaElisabeth WesterdahlPhD, Universitetssjukhuset i ÖrebroMalin WiklundPhD student, Sahlgrenska Universitetssjukhuset, Göteborg Scandinavian Conference in Cardiothoracic Surgery 2009

  3. Why do we need national guidelines?The aimof the guidelines is to gather the effects of respiratory physiotherapy treatments in thorax- and abdominal surgery and put it together with clinical experience. Scandinavian Conference in Cardiothoracic Surgery 2009

  4. How did we start? • Respiratory physiotherapy treatments between 1980-2008 • Written in english • Extensive search in seven medical databases Scandinavian Conference in Cardiothoracic Surgery 2009

  5. Search words • thoracic surgery • lung surgery • postoperative • chest physical therapy • breathing exercises • CPAP • Incentive spirometry • IPPB • positive expiratory pressure • pursed-lip breathing • resistance breathing Scandinavian Conference in Cardiothoracic Surgery 2009

  6. What studies did we choose? • Randomized controlled studies • Outcomes; secretion, hypoxia/hypercapnia,pulmonary volume, pneumonia,hospital time, ICD time, post pulmonarycomplications (atelectases, pneumonia), death. Scandinavian Conference in Cardiothoracic Surgery 2009

  7. The review 34 cardiac- and 5 pulmonary studies were reviewed 1. Classifying on the basis of Verhagen (Delphi method) 2. Systematic selection 3. SBU Scandinavian Conference in Cardiothoracic Surgery 2009

  8. Verhagen scoring • Questions about:RandomizationBlindingSelection Scandinavian Conference in Cardiothoracic Surgery 2009

  9. The review 34 cardiac- and 5 pulmonary studies were reviewed 1. Classifying on the basis of Verhagen (Delphi method) 2. Systematic selection 3. SBU Scandinavian Conference in Cardiothoracic Surgery 2009

  10. Systematic selection Specific respiratory treatment against an untreated control group 2. Specific respiratory treatment included in ordinary treatment compared with only ordinary treatment 3. One specific respiratory treatment against another specific respiratory treatment Scandinavian Conference in Cardiothoracic Surgery 2009

  11. The review 34 cardiac- and 5 pulmonary studies were reviewed 1. Classifying on the basis of Verhagen (Delphi method) 2. Systematic selection 3. SBU Scandinavian Conference in Cardiothoracic Surgery 2009

  12. Result • 34 cardiac studies Verhagen score(0-10)4 (> 7)30 (4-6)0 (0-3)Systematic selection7 (1)9 (2)19 (3) • 5 pulmonary studies Verhagen score(0-10) 0 (>7)5 (4-6)0 (0-3)Systematic selection3 (1)2 (2) Scandinavian Conference in Cardiothoracic Surgery 2009

  13. What kind of treatments has been studied? • Preoperative: fitness training, IS, IPPB, inspiratory muscle training • Postoperative: DB, ACBT, IS, PEP, IR-PEP, CPAP, IPPB, Bilevel-PAP, huff, cough, early mobilization, manual techniques Scandinavian Conference in Cardiothoracic Surgery 2009

  14. Where did the studies come from? • Cardiac studies15 Europe6 Canada5 USA4 Brazil3 Australia1 Israel • Pulmonary studies4 Europe1 Israel Scandinavian Conference in Cardiothoracic Surgery 2009

  15. National guidelines • Differences • Discussions • Evidence situation and clinical experience national guidelines • Finished during 2009 (www.LSR.se) Scandinavian Conference in Cardiothoracic Surgery 2009

  16. Possibilities • Read a lot of articles • Critical review • Discuss with experieced collegues • Run into ”new” treatments • National network • Create guidelines for colleagues Scandinavian Conference in Cardiothoracic Surgery 2009

  17. Difficulties • Frustration • Time Scandinavian Conference in Cardiothoracic Surgery 2009

  18. What about clinical guidelines in the other Nordic countries? • Have some of you worked with national guidelines? Scandinavian Conference in Cardiothoracic Surgery 2009

  19. Discussion • Do you have local guidelines at your hospital? • In what extent do you use guidelines in your clinical work? • What kind of things is important in a guideline document for the clinical physiotherapist? • How should we work with implementation of the guidelines? Scandinavian Conference in Cardiothoracic Surgery 2009

  20. Scandinavian Conference in Cardiothoracic Surgery 2009

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